Covid-19 & Diabetes – Questions & Answers

What is COVID-19?

Coronavirus is an umbrella name for virus transmitted to humans from animals. The current strain (COVID-19) is a new variation that until last December was not found in humans and because of that our understanding of how it operates and means to combat it are limited.

 

People with diabetes are considered a high-risk group because having diabetes causes the body to raise glucose levels during times of illness or stress which makes it more difficult to fight infection. Hence people with diabetes have an increased risk of moderate or severe illness.

 

People with diabetes have the same risk as people without diabetes of getting COVID-19 but if you get COVID-19, you are more at risk of serious illness.

 

How can I protect myself from COVID-19  (Updated March 30th)

This information is taken from the HSE website.

 

There are some groups of people who may be more at risk of moderate or serious illness if they get COVID-19.

 

Diabetes is in the ‘at risk’ group but this does not mean people with diabetes are at higher risk of getting COVID-19.

 

 

At-risk groups

You are more at risk of serious illness if you catch COVID-19 and you:

 

  • are 60 years of age and over – people over 70 are particularly vulnerable.
  • have a long-term medical condition – for example, heart disease, lung disease, diabetes, cancer, cerebrovascular disease, renal disease, liver disease or high blood pressure.
  • have a medical condition that can affect your breathing.
  • are a resident of a nursing home or other residential care setting.
  • are in specialist disability care and are over 50 years of age or have an underlying health problem.

 

 

Extremely vulnerable groups

You are advised to take additional precautions i.e. cocooning, see: https://www.gov.ie/en/publication/923825-guidance-on-cocooning-to-protect-people-over-70-years-and-those-extr/#what-we-mean-by-extremely-medically-vulnerable

 

if you are:

  • people aged 70 years or over.
  • solid organ transplant recipients.
  • people with specific cancers.
  • people with severe respiratory conditions including cystic fibrosis, severe asthma and severe COPD.
  • people with rare diseases and inborn errors of metabolism that significantly increase the risk of infections (such as SCID, homozygous sickle cell).
  • people on immunosuppression therapies sufficient to significantly increase risk of infection.
  • women who are pregnant with significant heart disease, congenital or acquired.

 

 

Extra care for people in at-risk groups

Everyone needs to stay at home to help slow the spread of COVID-19. You should only leave your home to:

  • attend medical appointments, collect medicine or other health products.
  • care for children, older people or other vulnerable people – this excludes social family visits.
  • exercise outdoors – within 2 kilometres of your home and only with members of your own household, keeping 2 metres distance between you and other people.
  • travel to work if you provide an essential service – be sure to practice physical distancing.

 

 

In addition you as a person in a high risk group are asked to:

Ask others to shop for you. They can leave supplies at your door.

You do not need to self-isolate unless you have symptoms of coronavirus.

If you are caring for someone in an at-risk group, follow the advice on how to protect yourself from coronavirus.

 

 

There is separate advice on the HSE website about:

 

Can I use Public Transport? (Updated March 30th)

 

Travel restrictions are as follows:

 

What about Work? ( Updated March 30th)

 

New public health measures announced by the Department of Health and Department of the Taoiseach valid from March 27th-April 12th to stop the spread of Covid 19, state that everyone should stay at home wherever possible.

Exceptions are:

 

  • those who can work from home, must work from home.

 

  • all essential services should ensure safe working conditions are in place for their employees.

 

  • if your employer notifies you that you are an essential employee, or that you belong to a category of essential employees, you are permitted to travel to and from work.

 

  • when travelling to and from work, you should at all times bring with you either a work identification or a letter from your employer indicating that you are an essential employee, as well as one other form of identification
  • If you are self-employed, a farmer or agricultural worker, or a member of the clergy, you should carry one form of identification with you at all times.

 

  • If you are a volunteer who is working as part of the national community response, you are permitted to travel for that purpose, for example, if you are delivering food, supplies or medicine to a person who is cocooned or vulnerable.

 

  • If you are not engaged in the provision of essential services, then you are not permitted to travel to and from work until 12 April 2020.

 

  • Many of you have been in touch with us wanting to know whether you should be working as a person with diabetes to cover essential services. We have been advising you to discuss with your employer about meeting safe work practices and reducing your risk. The HPSC published guidance on March 31st stating healthcare workers are unlikely to be at greater risk of acquiring COVID-19 compared with other healthcare workers. It advises that healthcare workers should continue to work UNLESS there is a specific recommendation from their treating specialist.

 

 

 

  • We would like to acknowledge and applaud all our essential workers and in particular to thank those with diabetes who continue to work on the frontline, but also to appreciate each individuals difficulty in making  this choice depending on their circumstances and on the people that depend on them.

 

 

 

Will I be able to get my Medications and Supplies? (Updated March 30th)

The Irish Pharmacy Union assures us that pharmacies will stay open and there is no issue with supplies, please see https://ipu.ie/home/news/irish-pharmacy-union-statement-on-covid-19-13march20/

 

Currently, pharmacies have increased numbers of people attending for advice and prescriptions. Please assist them by ringing ahead and arrange a date and time to collect your prescribed medications. If you cannot collect, you can arrange for another person to collect. However, the “Pharmacist must be satisfied that the person collecting the medicine has been authorised to do so by the patient and is of a sufficient age and maturity to safely deliver the medicine to the patient with any relevant information” (2020 HSE Primary Care Eligibility & Reimbursement Service). 

 

Generally, prescriptions are only valid for six months from the date they were written but currently pharmacists are to be allowed by law to dispense medicines outside the dates spelled out in prescriptions according to their own professional judgement. In addition, the pharmacist can only dispense one month’s supply of medications per month under the Primary Care Reimbursement Scheme.

 

Updated statement from Novo Nordisk confirming that are able to currently supply all products to the Irish market – Statement on Covid-19

 

 

What preparations should I do to prepare for getting COVID-19? (Updated March 30th)

It is generally accepted that there will be an onslaught of cases and over half the population will be infected. People with diabetes should prepare themselves so that they are in best possible health and have the necessary knowledge and supplies for when they need to self-treat any illness.

 

There are simple things you can do today to prepare yourself:

 

  • You should have a sick day regime to follow in case of illness – if you haven’t, get one from your diabetes team today.

 

  • For people with Type 1 diabetes – ensure you have ketone strips.

 

  • For people with Type 2 diabetes – know if you need to alter any medications.

 

  • Confirm with your diabetes team, what is acceptable glucose levels if home testing and when to contact them for assistance.

 

  • For anyone using a pump ensure they have insulins ( basal and bolus) to use in case of pump failure.

 

  • Make sure you have two weeks supply of medication where possible – ring the pharmacy and arrange date and time for collection the week before your script needs filling. Note Pharmacists are to be allowed by law to dispense medicines outside the dates spelled out in prescriptions according to their own professional judgement. In addition, the pharmacist can only dispense one month’s supply of medications per month under the Primary Care Reimbursement Scheme. 
  • Ensure you have an adequate supply of non-diet drinks i.e. soft drinks and simple foods that contain some sugar in case you cannot take solid foods.

 

  • Make sure you have a thermometer – the first question you will be asked if you need to seek medical attention is have you a fever (temperature above 38 °C or 100.4 °F ).

 

  • Do everything possible to maintain good glucose control.
    • for people with Type 2 diabetes or prediabetes, see Diabetes Smart.
    • for people with Type 1 diabetes, reinstate frequent glucose monitoring and insulin adjustment.

What are the symptoms of COVID-19?

 

The main symptoms to look out for are:
• A cough – this can be any kind of cough, not just dry.
• Shortness of breath.
• Breathing difficulties.
• Fever (temperature above 38 °C or 100.4 °F).
Other symptoms may include fatigue, headaches, sore throat, aches and pains.

 

What if I get a Mild Illness?

If you have diabetes and are feeling unwell, your blood glucose levels will rise which makes it more difficult to fight illness. Remember never stop your diabetes medications unless instructed as part of your Sick Day Regime.

Drink plenty of fluids to stay hydrated.

For people with diabetes on insulin therapy – Sick Day Leaflet – Type 1 for more information. This information is a general guide only. Each person should have their own individual Sick Day Regime. If you don’t have one, contact your own diabetes team today.

 

With Type 2 diabetes, you need to know which medications to alter if not eating – check with your pharmacist if any of the tablets or injections you are taking should be altered if you are unable to eat. Your Sick Day Regime should help you stay in control. Sick Day Leaflet – Type 2 for more information. This information is a general guide only. Each person should have their own individual Sick Day Regime. If you don’t have one, contact your own diabetes team today.

 

When should I seek Medical Help?

As with all medical conditions, if you cannot get the symptoms under control within two days or are in distress, you should seek professional assistance. For people with diabetes, that includes maintaining glucose levels in the target range. Ring your GP and await a call back as they are currently very busy.

 

Specific to COVID-19, if you have the flu like symptoms, contact the HSE helpline 1850 24 1850 for advice specific to the area of the county you live in. You should not attend your GP or hospital as you risk spreading whatever illness you might have. More information on https://www2.hse.ie/conditions/coronavirus/coronavirus.html

 

Covid- 19 and Meal Planning:

We can still access all supermarkets and the government has assured us this is the plan for the foreseeable future.

But we need to be mindful of social distancing so the numbers of people allowed into shops will be less than usual which may mean queuing, try to reduce any stress around shopping by taking time to plan and organise your meals for a full week. It is a good idea to write a shopping list in advance to reduce chances of impulse buying.

 

Top Tips for shopping with diabetes:

  • Plan the week’s meals, start with making a list and break this down to what’s needed meal by meal.
  • First up is breakfast: consider cereals you may need, remember to try choose higher fibre options like porridge Weetabix or similar higher fibre choices. Add fruit to meet our recommend intake of 5-7 portions daily or high fibre breads for variety.

 

Follow this with lunch and dinners; it may be a good idea to stick with family favourites as you will be more familiar with quantities required. We produced a shopping guide for people with diabetes which covers exactly how to put shopping lists together with lots of suggestions for each mealtime.

 

https://www.diabetes.ie/wp-content/uploads/2015/03/MSD_DFI_DiabetesShoppingGuide_Web21.pdf

 

See the table below for a list of store cupboard essentials

 

 

• Wholegrain Cereals
• Porridge Oats
• Pasta/Spaghetti/Couscous/Rice
• Pitta Pockets (Store in Freezer)
• Eggs • Tinned Tomatoes
• Tomato Puree
• Frozen Vegetables
• Baked Beans
• Tinned Fish – Mackerel, Sardines, Salmon, Tuna
• Pulses – lentils, Chickpeas, Kidney Beans or Butter Beans
• Fruit Tinned in Natural Juice
Sugar Free Jelly
• Stock Cubes (look for Reduced Salt Varieties)
• Low Fat/Fat Free Salad Dressing
• Mixed herbs
• Artificial sweetener
• No Added sugar Squash/Cordial
• Olive or Rapeseed Oil
• Seeds such as Linseed, Flaxseed, Pumpkin, Sesame or Sunflower
• Nuts e.g. Almonds, Walnuts, Cashew, Peanuts – Choose Plain Unsalted Varieties•

 

 

 

  • Check what you currently have… how much fresh / frozen and tinned ingredients you need for a week. Check for storage space and avoid panic buying as you may end up with a considerable amount of food waste.

 

  • There has been a huge amount of panic buying in the last couple of weeks where people have bulked up on dried ingredients (and toilet roll!) so stocks of pasta and rice might not be on the shelves when you visit. So, give yourself options and consider possible substitutes – maybe noodles, couscous, bulgur wheat or rice instead of pasta. These staples are not in short supply, it’s just hard for the supermarket chains to keep food on the shelves as people are currently buying more than they need.

 

  • All fresh foods and staples such as potatoes and vegetables are freely available at present and we have been told all the grocery stores report no disruption to supply lines.

 

  • Check your cupboards for spices and herbs that can be added to tinned tomatoes and can bring flavour to meals.

 

  • Pulses such as lentils, beans and chickpeas will bulk up on fibre and protein – use in soups, stews, casseroles and family favourites like cottage pie.

 

  • If you find yourself with less money than usual or are worried about future income see the link below produced by the Money Advice and Budgeting Service (MABS) in conjunction with safefood where they have 101 square meals these are easy to prepare meals aimed at families who are shopping on a budget.

 

https://www.safefood.eu/SafeFood/media/SafeFoodLibrary/Documents/Healthy%20Eating/101_Square_Meals.pdf

  • Remember to try support local shops and producers where possible. You might only need a few essentials things like bread, milk or vegetables to get by for a day or 2. Short outings being mindful of social distancing may keep stress levels down too.

 

  • Try out new recipes especially if you have children at home – maybe try a recipe a week and get children to pick and plan something they would like to try. We have lots of recipes on our website from family meals such as our chicken curry or shepherd’s pie to kid’s favourites like pancakes and carrot and pineapple squares, there’s plenty to keep them busy while school is off.

 

https://www.diabetes.ie/living-with-diabetes/living-with-type-2/food-diabetes/recipes/

If you need to self-isolate think about shopping online where food can be delivered to your door or arranged to be picked up at a store by a family member.

 

There has been an outpouring of goodwill in recent days… we need to continue to drive the momentum of coming together and to tackle and support each other though this crisis…so think about your neighbours – is there anymore more vulnerable or elderly that you could help…similarly maybe you are that vulnerable person yourself… don’t hold back on asking for help or indeed offering it.

 

If you have food that’s about to go out of date or if you need some your neighbour may have try be savvy about supporting each other while keeping to safe practice.

 

https://www2.hse.ie/conditions/coronavirus/protect-yourself.html

 

We don’t know how long this period may last and exactly what we are about to face into, there will be tough times ahead… so minding our mental as well as our physical health with diabetes will be vitally important going forward.

 

Many people are worried about how to manage their shopping and the risk of COVID-19. These guidelines outline how best to minimise risk. https://static.rasset.ie/documents/news/2020/04/pol26-safe-shopping-guidelines-covid-19-2.pdf

 

 

Help keep our helpline and information platforms going, donate today!

 

 

What about my Mental Health?

We understand diabetes can be particularly challenging at the best of times but with all this uncertainty for everyone, it is more important than ever to look after our mental health as well as our diabetes.We know times of stress can affect blood glucose levels along with symptoms of illness such as colds or viral infections so try to not become too overwhelmed with all the information overload on Covid-19.

 

 

The HSE website has lots of useful information on protecting yourself against Covid-19 and what to look out for, the sections below are have been adapted from their website. The spread of coronavirus is a new and challenging event. Some people might find it more worrying than others. Try to remember that medical, scientific and public health experts are working hard to contain the virus.

 

Most people’s lives will change in some way over a period of days, weeks or months. But in time, it will pass.
You may notice that you have increase feelings of anxiety, stress and you may be constantly checking for raised glucose levels. You make fear that an ache, pain or cough might be the virus whereas before these may have gone unnoticed.

 

We have noted these are all common concerns from the volume of calls we are getting to the Helpline and from the number of queries on Facebook and to our info box because diabetes has been listed as an underlying condition.
So it is important first and foremost to stay safe but also to acknowledge your feelings around anxiety and stress but maybe also to step back, ask for help and try not to get overwhelmed.

 

How to mind your Mental Health during this time

Keeping a realistic perspective of the situation based on facts is important.

 

Here are some ways you can do this.

  • Stay informed but set limits for news and social media.
  • The constant stream of social media updates and news reports about coronavirus could cause you to feel worried.
  • Sometimes it can be difficult to separate facts from rumours. Use trustworthy and reliable sources to get your news.

 

Read up-to-date, factual information on coronavirus in Ireland here.

 

On social media, people may talk about their own worries or beliefs. You don’t need to make them your own.

Too much time on social media may increase your worry and levels of anxiety.

Consider limiting how much time you spend on social media.

If you find the coverage on coronavirus is too intense for you, talk it through with someone close or get support, call us on our helpline on 01 8428118 if you have a particular query around your diabetes.

Keep up your healthy routines.

Your routine may be affected by the coronavirus outbreak in different ways. But during difficult times like this, it’s best if you can keep some structure in your day.

It’s important to pay attention to your needs and feelings, especially during times of stress. You may still be able to do some of the things you enjoy and find relaxing.

 

 

For example, you could try to:
• Exercise regularly, especially walking – you can do this even if you need to self-quarantine.
• Keep regular sleep routines.
• Maintain a healthy, balanced diet.
• Avoid excess alcohol.
• Practice relaxation techniques such as breathing exercises.
• Read a book.
• Follow your diabetes team advice on glucose testing.. there is no need to increase testing unless you feel unwell.

 

Stay connected to others

During times of stress, friends and families can be a good source of support. It is important to keep in touch with them and other people in your life.

 

If you’re advised to limit your social contact to contain coronavirus, try to stay connected to people in other ways. E-mail, social media, video calls or phone calls can help you to stay social during this time.

 

Remember that talking things through with someone can help lessen worry or anxiety.

You don’t have to appear to be strong or to try to cope with things by yourself.

Talking to children and young people.

Involving your children in your plans to manage this situation is important. Try to consider how they might be feeling.

 

Give children and young people the time and space to talk about the outbreak. Share the facts with them in a way that suits their age and temperament, without causing alarm.

 

Talk to your children about coronavirus but try to limit their exposure to news and social media.

 

This is especially important for older children who may be spending more time online now. It may be causing anxiety.

 

 

Try to anticipate distress and support each other

It is understandable to feel vulnerable or overwhelmed reading or hearing news about the outbreak.

 

Acknowledge these feelings. Remind yourself and others to look after your physical and mental health.

 

If you smoke or drink, try to avoid doing this any more than usual. It won’t help in the long-term.

 

Don’t make assumptions.

 

Don’t judge people or make assumptions about who is responsible for the spread of the disease.

 

The coronavirus can affect anyone regardless of age, gender, nationality or ethnicity. We are all in this together.

 

Online and phone supports

Face-to-face interaction may be limited during this period.

 

There are many online mental health resources and phone services that can help.

 

Contact Diabetes Ireland on 01 8428118 if you are concerned about your diabetes and speak to one of our healthcare professionals.

 

Our office hours are 9-5 Monday to Friday and our email is [email protected]

 

Help keep our helpline and information platforms going, donate today!

 

 

Diabetes and Covid-19 Risk Groups

 

Managing Diabetes During Illness